Tuberculosis (TB) Nursing Care Plan & Management

Notes

Description

Tuberculosis (TB) or known as the White Plague during the 19thcentury, has inflicted the human race ever since. It is described as a chronic infectious disease caused by an organism called Mycobacterium tuberculosis through droplet transmission, like coughing, sneezing, or if the person inhales the infected droplet.
It can be considered as primary or secondary infection depending on recovery of the client from the communicable infection. It is a reportable communicable disease and a repeated exposure to it causes a person to acquire it.

According to a study conducted by Knechel, the progression of tuberculosis has several stages.

Latent Tuberculosis – It is the stage of infection when the person who had been exposed to the M. tuberculosis nuclei does not manifest signs and symptoms of the disease and do not have the capacity to infect other people. The nuclei just persist in the system in its necrotic form which could stay for a long time, not until that immunosuppression or a certain factor triggers it to become its virulent form.

Primary Pulmonary Tuberculosis – Since the most immediate location of pathogenesis of the organism is in the lungs, primary activation of disease in the pulmonary cavity is considered. It is usually asymptomatic and only identified through significant diagnostic examinations. Only the presence of lymphadenopathy is something that is indicative for its infection.

Primary Progressive Tuberculosis – It is the stage of the disease process when it is already considered as active. Clinical manifestations are evident and the client may reveal positive in sputum examination for presence of the organism. Sometimes, he or she may manifest cough with purulent sputum and some pleuritic chest pains because of inflammation in the parenchymal walls.

Extrapulmonary Tuberculosis – It is when tuberculosis extends its infection to other parts of the aside from the pulmonary cavity. The most fatal location is the central nervous system and its infection to the bloodstream. Other locations may include the lymphatic system, the bones and joints and at times the genitourinary system.
Tuberculosis(TB) Pathophysiology

Clinical Manifestations of Tuberculosis

Easy fatigability

Anorexia or loss of appetite

Weight loss and body wasting

Persistent, long term low- grade fever

Chills and night sweats

Persistent, progressive cough which may be non-productive at first but may produce purulent sputum in the long term (2 weeks or more)

Non-resolving bronchopneumonia

Dull or pleuritic chest pains

Dyspnea

Hemoptysis

Anemia in some

Pathophysiology

Exam

MSN Exam for Pneumonia and Tuberculosis (PM)

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!

Start

Congratulations - you have completed MSN Exam for Pneumonia and Tuberculosis (PM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

An 87-year-old client requires long term ventilator therapy. He has a tracheostomy in place and requires frequent suctioning. Which of the following techniques is correct?

A

Using continuous suction while withdrawing the catheter.

B

Using intermittent suction while advancing the catheter.

C

Using intermittent suction while withdrawing the catheter.

D

Using continuous suction while advancing the catheter.

Question 1 Explanation:

Intermittent suction should be applied during catheter withdrawal. To prevent hypoxia, suctioning shouldn’t last more than 10-seconds at a time. Suction shouldn’t be applied while the catheter is being advanced.

Question 2

A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and difficulty expelling his secretions. The nurse auscultates his lung fields and hears bronchial sounds in the left lower lobe. The nurse determines that the client requires which of the following treatments first?

A

Antibiotics

B

Bed rest

C

Nutritional intake

D

Oxygen

Question 2 Explanation:

The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a physicians order. Antibiotics may be warranted, but this isn’t a nursing decision. The client should be maintained on bedrest if he is dyspneic to minimize his oxygen demands, but providing additional will deal more immediately with his problem. The client will need nutritional support, but while dyspneic, he may be unable to spare the energy needed to eat and at the same time maintain adequate oxygenation.

Question 3

Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?

A

Collapsed alveoli increase oxygen demand

B

Alveoli have no effect on oxygenation

C

Gaseous exchange occurs in the alveolar membrane.

D

Alveoli need oxygen to live

Question 3 Explanation:

Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand, though by decreasing the surface area available for gas exchange, they decrease oxygenation of the blood.

Question 4

A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?

A

ABG analysis

B

Blood cultures

C

Chest x-ray

D

sputum culture and sensitivity

Question 4 Explanation:

Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the pneumonia, and blood cultures will help determine if the infection is systemic.

Question 5

When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation?

A

Tubular

B

Bronchial

C

Bronchovestibular

D

Vesicular

Question 5 Explanation:

Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchiovesicular are normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in the bases of the lung fields.

Question 6

Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?

A

Effusion

B

Bronchiectasis

C

Inflammation

D

Atelectasis

Question 6 Explanation:

The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiecrasis indicate a collapse of a portion of the airway that doesn’t occur in pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia.

Question 7

An elderly client with pneumonia may appear with which of the following symptoms first?

A

Fever and chills

B

Altered mental status and dehydration

C

Pleuritic chest pain and cough

D

Hemoptysis and dyspnea

Question 7 Explanation:

Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

Question 8

Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?

A

stick a needle in the area of decreased breath sounds

B

Have the client use an incentive spirometer

C

Take a chest x-ray

D

Auscultate breath sounds

Question 8 Explanation:

A chest x-ray will show the area of collapsed lung if pneumothorax is present as well as the volume of air in the pleural space. Listening to breath sounds won’t confirm a diagnosis. An IS is used to encourage deep breathing. A needle thoracostomy is done only in an emergency and only by someone trained to do it.

Question 9

Which of the following symptoms is common in clients with TB?

A

Weight loss

B

Dyspnea on exertion

C

Mental status changes

D

Increased appetite

Question 9 Explanation:

TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats.

Question 10

Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply.

A

Presence of chest pain.

B

Color of nail beds

C

Presence of peripheral edema

D

Auscultation of bowel sounds

E

Auscultation of breath sounds

Question 10 Explanation:

A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the patient with pneumonia.

Question 11

Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods?

A

The mask provides pressurized at the end of expiration to open collapsed alveoli.

B

The mask provides continuous air that the client can breathe.

C

The mask provides pressurized oxygen so the client can breathe more easily.

D

The mask provides 100% oxygen to the client.

Question 11 Explanation:

The mask provides pressurized oxygen continuously through both inspiration and expiration. The mask can be set to deliver any amount of oxygen needed. By providing the client with pressurized oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe. Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not continuous positive airway pressure.

Question 12

A client with pneumonia has a temperature ranging between 101* and 102*F and periods of diaphoresis. Based on this information, which of the following nursing interventions would be a priority?

A

Provide fluid intake of 3 L/day

B

Provide frequent linen changes.

C

Administer oxygen therapy

D

Maintain complete bedrest

Question 12 Explanation:

A fluid intake of at least 3 L/day should be provided to replace any fluid loss occurring as a result the fever and diaphoresis; this is a high-priority intervention.

Question 13

A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this?

A

Chronic bronchitis

B

Pneumonia

C

Acute asthma

D

Spontaneous pneumothorax

Question 13 Explanation:

A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.

Question 14

A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection?

A

5/8” to ½” 25G to 27G needle.

B

½” to 3/8” 26 or 27G needle.

C

1” 20G needle.

D

1” to 3” 20G to 25G needle.

Question 14 Explanation:

Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a local effect. A TB syringe with a ½” to 3/8” 26G or 27G needle should be inserted about 1/8” below the epidermis.

Question 15

A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of breath. He reports that it started suddenly. The assessment should include which of the following interventions?

A

Echocardiogram

B

Electrocardiogram (ECG)

C

Chest x-ray

D

Auscultation of breath sounds

Question 15 Explanation:

Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client’s pain is identified, he won’t need an echocardiogram.

Question 16

A client’s ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and HCO3– of 24 mEq/L. What do these values indicate?

A

Metabolic alkalosis

B

Metabolic acidosis

C

Respiratory acidosis

D

Respiratory alkalosis

Question 17

A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which action should the nurse take?

A

Leave the airway in place until the client gets used to it.

B

Reposition the airway.

C

Remove the airway and attempt suctioning without it.

D

Remove the airway and insert a shorter one.

Question 17 Explanation:

If a client gags or coughs after nasopharyngeal airway placement, the tube may be too long. The nurse should remove it and insert a shorter one. Simply repositioning the airway won’t solve the problem. The client won’t get used to the tube because it’s the wrong size. Suctioning without a nasopharyngeal airway causes trauma to the natural airway.

Question 18

A client was infected with TB 10 years ago but never developed the disease. He’s now being treated for cancer. The client begins to develop signs of TB. This is known as which of the following types of infection?

A

Tertiary infection

B

Primary infection

C

Superinfection

D

Active infection

Question 18 Explanation:

Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection containing TB bacilli may remain inactive for years and then activate when the client’s resistance is lowered, as when a client is being treated for cancer. There’s no such thing as tertiary infection, and superinfection doesn’t apply in this case.

Question 19

A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has:

A

Developed a resistance to tubercle bacilli

B

Developed passive immunity to TB.

C

Had contact with Mycobacterium tuberculosis

D

Active TB

Question 19 Explanation:

A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.

Question 20

The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply.

A

“It is important that I isolate myself from family when possible.”

B

“I can use regular plate and utensils whenever I eat.”

C

“I should always cover my mouth and nose when sneezing.”

D

“I should use paper tissues to cough in and dispose of them properly.”

E

“I will need to dispose of my old clothing when I return home.”

Question 21

A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be consistent with the usual clinical presentation of TB and may indicate the development of a concurrent problem?

A

Chills and night sweats

B

Anorexia and weight loss

C

Nonproductive or productive cough

D

High-grade fever

Question 21 Explanation:

The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.

Question 22

Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present?

A

Dehydration

B

Severe periodontal disease

C

Group living

D

Malnutrition

Question 22 Explanation:

Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases the chance of disease transmission.

Question 23

What effect does hemoglobin amount have on oxygenation status?

A

No effect

B

Low hemoglobin levels cause reduces oxygen-carrying capacity

C

Low hemoglobin levels cause increased oxygen-carrying capacity.

D

More hemoglobin reduces the client’s respiratory rate

Question 23 Explanation:

Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal levels.

Question 24

A high level of oxygen exerts which of the following effects on the lung?

The nurse obtains a sputum specimen from a client with suspected TB for laboratory study. Which of the following laboratory techniques is most commonly used to identify tubercle bacilli in sputum?

A

Sensitivity testing

B

Acid-fast staining

C

Dark-field illumination

D

Agglunitnation testing

Question 25 Explanation:

The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.

Question 26

Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?

A

Chest tube placement

B

Bronchodilators

C

Antibiotics

D

Hyperbaric chamber

Question 26 Explanation:

The only way to reexpand the lung is to place a chest tube on the right side so the air in the pleural space can be removed and the lung reexpanded.

Question 27

A client has active TB. Which of the following symptoms will he exhibit?

A

Fever of more than 104ºF and nausea

B

Headache and photophobia

C

Chest and lower back pain

D

Chills, fever, night sweats, and hemoptysis

Question 27 Explanation:

Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing, but isn’t usual. Clients with TB typically have low-grade fevers, not higher than 102*F. Nausea, headache, and photophobia aren’t usual TB symptoms.

Question 28

A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions?

A

Give a tuberculin test and tell him to come back in 48 hours and have it read.

B

Prescribe isoniazid and tell him to go home and rest

C

Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home.

D

Admit him to the hospital in respiratory isolation

Question 28 Explanation:

The client is showing s/s of active TB and, because of the productive cough, is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they’re negative, he would be considered non-contagious and may be sent home, although he’ll continue to take the antitubercular drugs for 9 to 12 months.

Question 29

A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse interprets the results as:

A

Inconclusive

B

Positive

C

Negative

D

The need for repeat testing.

Question 29 Explanation:

The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.

Question 30

Which of the following antituberculus drugs can cause damage to the eighth cranial nerve?

A

Ethambutol hydrochloride

B

Isoniazid

C

Para-aminosalicylic acid

D

Streptomycin

Question 30 Explanation:

Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from amintoglycodsides.

Question 31

Which of the following family members exposed to TB would be at highest risk for contracting the disease?

A

76-year-old grandmother

B

45-year-old mother

C

8-year-old son

D

17-year-old daughter

Question 31 Explanation:

Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.

Question 32

A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse suggests that the client increase intake of:

A

Potatoes and fish

B

Grains and broccoli

C

Eggs and spinach

D

Meats and citrus fruits

Question 32 Explanation:

The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.

Question 33

Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client’s history, would require physician notification?

A

Hepatitis B

B

Rheumatic fever

C

Heart disease

D

Allergy to penicillin

Question 33 Explanation:

Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.

Question 34

A client with a positive skin test for TB isn’t showing signs of active disease. To help prevent the development of active TB, the client should be treated with isonaizid, 300mg daily, for how long?

A

10 to 14 days

B

3 to 6 months

C

2 to 4 weeks

D

9 to 12 months

Question 34 Explanation:

Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoaizid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.

Question 35

Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?

A

Depression

B

Irritability

C

Coma

D

Apathy

Question 35 Explanation:

Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.

Question 36

A community health nurse is conducting an educational session with community members regarding TB. The nurse tells the group that one of the first symptoms associated with TB is:

A

A bloody, productive cough

B

Dyspnea

C

A cough with the expectoration of mucoid sputum

D

Chest pain

Question 36 Explanation:

One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum.

Question 37

A 76-year old client is admitted for elective knee surgery. Physical examination reveals shallow respirations but no signs of respiratory distress. Which of the following is a normal physiologic change related to aging?

A

Decreased vital capacity

B

Increased elastic recoil of the lungs

C

Increased number of functional capillaries in the alveoli

D

Decreased residual volume

Question 37 Explanation:

Reduction in VC is a normal physiologic change in the older adult. Other normal physiologic changes include decreased elastic recoil of the lungs, fewer functional capillaries in the alveoli, and an increase is residual volume.

Question 38

Which of the following organisms most commonly causes community-acquired pneumonia in adults?

A

Haemiphilus influenzae

B

Steptococcus pneumoniae

C

Staphylococcus aureus

D

Klebsiella pneumoniae

Question 38 Explanation:

Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.

Question 39

A pulse oximetry gives what type of information about the client?

A

Amount of carbon dioxide in the blood

B

Amount of oxygen in the blood

C

Respiratory rate

D

Percentage of hemoglobin carrying oxygen

Question 39 Explanation:

The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn’t ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue.

Question 40

A client is experiencing confusion and tremors is admitted to a nursing unit. An initial ABG report indicates that the PaCO2 level is 72 mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets that the client is most likely experiencing:

A

Carbon dioxide narcosis

B

Carbon monoxide poisoning

C

Metabolic acidosis

D

Respiratory alkalosis

Question 40 Explanation:

Carbon dioxide narcosis is a condition that results from extreme hypercapnia, with carbon dioxide levels in excess of 70 mm Hg. The client experiences symptoms such as confusion and tremors, which may progress to convulsions and possible coma.

Question 41

INH treatment is associated with the development of peripheral neuropathies. Which of the following interventions would the nurse teach the client to help prevent this complication?

A

Adhere to a low cholesterol diet

B

Supplement the diet with pyridoxine (vitamin B6)

C

Avoid excessive sun exposure.

D

Get extra rest

Question 41 Explanation:

INH competes with the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed.

Question 42

A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by intravenous infusion. The nurse would determine that a therapeutic blood level exists if which of the following were noted in the laboratory report?

A

30 mcg/mL

B

5 mcg/mL

C

25 mcg/mL

D

15 mcg/mL

Question 42 Explanation:

The therapeutic theophylline blood level range from 10-20 mcg/mL.

Question 43

A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?

Pneumonia is an acute infection of the lung parenchyma. The inflammatory reaction may cause an outpouring of exudate into the alveolar spaces, leading to an ineffective airway clearance related to retained secretions.

Question 44

A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would the client show if therapy is inadequate?

A

Positive acid-fast bacilli in a sputum sample after 2 months of treatment.

B

Nonproductive cough

C

Improved chest x-ray

D

Decreased shortness of breath

Question 44 Explanation:

Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.

Question 45

A client with pneumonia has a temperature of 102.6*F (39.2*C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care?

A

Nasotracheal suctioning to clear secretions

B

Position changes q4h

C

Frequent linen changes

D

Frequent offering of a bedpan.

Question 45 Explanation:

Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.

Question 46

The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which nursing action would be most appropriate for this client?

A

Notify the physician of the client’s non-compliance and request a different prescription.

B

Ask the client’s spouse to supervise the daily administration of the medications.

C

Visit the clinic weekly to ask him whether he is taking his medications regularly.

D

Remind the client that TB can be fatal if not taken properly.

Question 46 Explanation:

Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.

Question 47

The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?

A

Pleural effusion

B

Decreased oxygenation of the blood.

C

Decreased cardiac output

D

Inadequate peripheral circulation

Question 47 Explanation:

A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation.

Question 48

A client with primary TB infection can expect to develop which of the following conditions?

A

Active TB within 1 month

B

A positive skin test

C

Active TB within 2 weeks

D

A fever that requires hospitalization

Question 48 Explanation:

A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in many cases because of a break in the body’s immune defenses. The active stage shows the classic symptoms of TB: fever, hemoptysis, and night sweats.

Question 49

The Causative agent of Tuberculosis is said to be:

A

Mycobacterium Tuberculosis

B

Bacillus Anthracis

C

Group A Beta Hemolytic Streptococcus

D

Hansen’s Bacilli

Question 50

The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be read as having which of the following results?

A

Positive

B

Negative

C

Needs to be redone

D

Indeterminate

Question 50 Explanation:

This test would be classed as negative. A 5mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn’t a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it’s considered positive according to the CDC.

Question 51

Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia?

A

A maximum loss of 5 to 10 pounds of body weight

B

The ability to perform ADL’s without dyspnea

C

Chest pain that is minimized by splinting the ribcage.

D

A respiratory rate of 25 to 30 breaths per minute

Question 51 Explanation:

An expected outcome for a client recovering from pneumonia would be the ability to perform ADL’s without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/minute indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5-10 pounds is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.

Question 52

A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the following reasons is this done?

A

To determine if this is a primary or secondary infection

B

To determine if a repeat skin test is needed

C

To confirm the diagnosis

D

To determine the extent of the lesions

Question 52 Explanation:

If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-negative skin test results. A chest x-ray can’t determine if this is a primary or secondary infection.

Question 53

If a pleural effusion develops, which of the following actions best describes how the fluid can be removed from the pleural space and proper lung status restored?

A

Performing thoracentesis

B

Inserting a chest tube

C

Allowing the pleural effusion to drain by itself.

D

Performing paracentesis

Question 53 Explanation:

Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy, infection, or inflammatory process. A chest tube is rarely necessary because the amount of fluid typically isn’t large enough to warrant such a measure. Pleural effusions can’t drain by themselves.

Question 54

A client diagnosed with active TB would be hospitalized primarily for which of the following reasons?

A

To determine his compliance

B

To determine the need for antibiotic therapy.

C

to prevent spread of the disease

D

To evaluate his condition

Question 54 Explanation:

The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he’s put in respiratory isolation in the hospital.

Question 55

The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?

A

Limit alcohol intake

B

Double the dosage if a drug dose is forgotten

C

Increase intake of dairy products

D

Take the medication with antacids

Question 55 Explanation:

INH and rifampin are hepatoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.

Question 56

Which of the following best describes pleural effusion?

A

The fluid in the alveolar space

B

The collapse of alveoli

C

The accumulation of fluid between the linings of the pleural space.

D

The collapse of bronchiole

Question 56 Explanation:

The pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatics. Any condition that interferes with either the secretion or drainage of this fluid will lead to a pleural effusion.

Question 57

The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?

A

Difficulty swallowing

B

Impaired vision

C

Facial paralysis

D

Vertigo

Question 57 Explanation:

The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve.

Question 58

The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a physicians order. Antibiotics may be warranted, but this isn’t a nursing decision. The client should be maintained on bedrest if he is dyspneic to minimize his oxygen demands, but providing additional will deal more immediately with his problem. The client will need nutritional support, but while dyspneic, he may be unable to spare the energy needed to eat and at the same time maintain adequate oxygenation.

A

Fever of 102ºF

B

Vesicular breath sounds in right base

C

Respiratory rate of 32 breaths/minute

D

Continued dyspnea

Question 58 Explanation:

If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he should be examined by the physician before discharge because he may have another source of infection or still have pneumonia.

Question 59

A chest x-ray should a client’s lungs to be clear. His Mantoux test is positive, with a 10mm if induration. His previous test was negative. These test results are possible because:

A

He had TB in the past and no longer has it.

B

He’s a “seroconverter”, meaning the TB has gotten to his bloodstream.

C

He was successfully treated for TB, but skin tests always stay positive.

D

He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.

Question 59 Explanation:

A tuberculin converter’s skin test will be positive, meaning he has been exposed to an infected with TB and now has a cell-mediated immune response to the skin test. The client’s blood and x-ray results may stay negative. It doesn’t mean the infection has advanced to the active stage. Because his x-ray is negative, he should be monitored every 6 months to see if he develops changes in his x-ray or pulmonary examination. Being a seroconverter doesn’t mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.

Question 60

Which of the following diagnostic tests is definitive for TB?

A

Sputum culture

B

Chest x-ray

C

Tuberculin test

D

Mantoux test

Question 60 Explanation:

The sputum culture for Myobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.

Once you are finished, click the button below. Any items you have not completed will be marked incorrect.
Get Results

There are 60 questions to complete.

←

List

→

Return

Shaded items are complete.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

End

Return

You have completed

questions

question

Your score is

Correct

Wrong

Partial-Credit

You have not finished your quiz. If you leave this page, your progress will be lost.

Rationale: Helps patient realize or accept necessity of adhering to medication regimen to prevent reactivation or complication. Understanding of how the disease is passed and awareness of transmission possibilities help patient and SO take steps to prevent infection of others.

Identify others at risk like household members, close associates and friends.

Rationale: Those exposed may require a course of drug therapy to prevent spread or development of infection.

Instruct patient to cough or sneeze and expectorate into tissue and to refrain from spitting. Review proper disposal of tissue and good hand washing techniques. Encourage return demonstration.

Rationale: Behaviors necessary to prevent spread of infection.

Review necessity of infection control measures. Put in temporary respiratory isolation if indicated.

Rationale: May help patient understand need for protecting others while acknowledging patient’s sense of isolation and social stigma associated with communicable diseases. AFB can pass through standard masks; therefore, particulate respirators are required.

Monitor temperature as indicated.

Rationale: Febrile reactions are indicators of continuing presence of infection.

Rationale: Contagious period may last only 2–3 days after initiation of chemotherapy, but in presence of cavitation or moderately advanced disease, risk of spread of infection may continue up to 3 months. Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered.

Review importance of follow-up and periodic reculturing of sputum for the duration of therapy.

Rationale: These second-line drugs may be required when infection is resistant to or intolerant of primary drugs or may be used concurrently with primary anti tubercular drugs. MDR-TB requires minimum of 18–24 mo therapy with at least three drugs in the regimen known to be effective against the specific infective organism and which patient has not previously taken. Treatment is often extended to 24 mo in patients with severe symptoms or HIV infection.

Encourage selection and ingestion of well-balanced meals. Provide frequent small “snacks” in place of large meals as appropriate.

Rationale: Patient who has three consecutive negative sputum smears (takes 3–5 mo), is adhering to drug regimen, and is asymptomatic will be classified a non transmitter.

Rationale: INH is usually drug of choice for infected patient and those at risk for developing TB. Short-course chemotherapy, including INH, rifampin (for 6 mo), PZA, and ethambutol or streptomycin, is given for at least 2 mo (or until sensitivities are known or until serial sputums are clear) followed by 3 more months of therapy with INH.Ethambutol should be given if central nervous system (CNS) or disseminated disease is present or if INH resistance is suspected.

Rationale: Extended therapy (up to 24 mo) is indicated for reactivation cases, extrapulmonary reactivated TB, or in the presence of other medical problems, such as diabetes mellitus or silicosis. Prophylaxis with INH for 12 mo should be considered in HIV-positive patients with positive PPD test.

Nursing Diagnosis

Airway Clearance, ineffective

May be related to

Thick, viscous, or bloody secretions

Fatigue, poor cough effort

Tracheal/pharyngeal edema

Possibly evidenced by

Abnormal respiratory rate, rhythm, depth

Abnormal breath sounds (rhonchi, wheezes), stridor

Dyspnea

Desired Outcomes

Maintain patent airway.

Expectorate secretions without assistance.

Demonstrate behaviors to improve/maintain airway clearance.

Participate in treatment regimen, within the level of ability/situation.

Identify potential complications and initiate appropriate actions.

Nursing Interventions

Rationale: Diminished breath sounds may reflect atelectasis. Rhonchi, wheezes indicate accumulation of secretions and inability to clear airways that may lead to use of accessory muscles and increased work of breathing

Rationale: Expectoration may be difficult when secretions are very thick as a result of infection and/or inadequate hydration. Blood-tinged or frankly bloody sputum results from tissue breakdown (cavitation) in the lungs or from bronchial ulceration and may require further evaluation or intervention.

Place patient in semi or high-Fowler’s position. Assist patient with coughing and deep-breathing exercises.

Nursing Interventions

Rationale: Pulmonary TB can cause a wide range of effects in the lungs, ranging from a small patch of bronchopneumonia to diffuse intense inflammation, caseous necrosis, pleural effusion, and extensive fibrosis. Respiratory effects can range from mild dyspnea to profound respiratory distress. Use of a scale to evaluate dyspnea helps clarify degree of difficulty and changes in condition.

Nursing Interventions

Document patient’s nutritional status on admission, noting skin turgor, current weight and degree of weight loss, integrity of oral mucosa, ability or inability to swallow, presence of bowel tones, history of nausea and vomiting or diarrhea.

Rationale: Useful in defining degree or extent of problem and appropriate choice of interventions.

Ascertain patient’s usual dietary pattern. Include in selection of food.

Desired Outcomes

Initiate behaviors/lifestyle changes to improve general well-being and reduce risk of reactivation of TB.

Identify symptoms requiring evaluation/intervention.

Describe a plan for receiving adequate follow-up care.

Verbalize understanding of therapeutic regimen and rationale for actions.

Nursing Interventions

Assess patient’s ability to learn. Note level of fear, concern, fatigue, participation level; best environment in which patient can learn; how much content; best media and language; who should be included.

Rationale: Learning depends on emotional and physical readiness and is achieved at an individual pace.

Provide instruction and specific written information for patient to refer to schedule for medications and follow-up sputum testing for documenting response to therapy.

Rationale: Written information relieves patient of the burden of having to remember large amounts of information. Repetition strengthens learning.

Encourage patient and SO to verbalize fears and concerns. Answer questions factually. Note prolonged use of denial.

Explain medication dosage, frequency of administration, expected action, and the reason for long treatment period. Review potential interactions with other drugs and substances.

Rationale: Enhances cooperation with therapeutic regimen and may prevent patient from discontinuing medication before cure is truly affected. Directly observed therapy (DOT) is the treatment of choice when patient is unable or unwilling to take medications as prescribed.

Rationale: DOT by community nurses is often the most effective way to ensure patient adherence to therapy. Monitoring can include pill counts and urine dipstick testing for presence of antitubercular drug. Patients with MDR-TB may be monitored with monthly sputum specimens for AFB smear and culture. Note:In some states, there are legal means for involuntary confinement for care if efforts to ensure patient adherence are ineffective.